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Published in: Rheumatology International 7/2016

01-07-2016 | Observational Research

Prevalence and predictors of vitamin D insufficiency in supplemented and non-supplemented women with systemic lupus erythematosus in the Mediterranean region

Authors: Tarek Carlos Salman-Monte, Vicenç Torrente-Segarra, M. Almirall, Patricia Corzo, Sergi Mojal, Jordi Carbonell-Abelló

Published in: Rheumatology International | Issue 7/2016

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Abstract

It has been previously reported that vitamin D deficiency is more prevalent among SLE patients than in the general population. We sought to determine the prevalence of vitamin D insufficiency and deficiency and their related factors, its relationship to SLE symptoms and disease activity on a group of supplemented and non-supplemented female SLE patients from the Mediterranean region. We performed a cross-sectional study including female SLE patients who regularly attended the outpatient Lupus Unit at Parc de Salut Mar-IMAS in Barcelona, from January 2012 to May 2014. Collected data were sociodemographics, vitamin D supplementation, fatigue degree visual analog scale, pharmacological treatment, main SLE serological markers, indexes, scales and plasma levels of 25-hydroxyvitamin D. One hundred and two consecutive female SLE patients were included. Vitamin D overall insufficiency and deficiency were exhibited by 46 and 22.5 % of patients, respectively. Vitamin D insufficiency was found in 50 % of supplemented and 60 % of non-supplemented patients. Among non-supplemented female SLE patients, it was found that patients with vitamin D insufficiency showed more fatigue (p = 0.009) and received more oral corticosteroids (p = 0.02) than those with normal levels. Patients with vitamin D insufficiency (supplemented and non-supplemented) received more oral corticosteroids than those without insufficiency (p = 0.008). Vitamin D insufficiency is highly prevalent among female SLE patients, even in southern regions. Non-supplemented female SLE patients showed more fatigue and received more oral corticosteroids than those with normal levels of vitamin D. These data were not found in supplemented patients although having a high prevalence of vitamin D insufficiency (up to 50 %). Further studies with longer follow-up and larger population are needed to confirm our observations.
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Literature
1.
go back to reference Hendy GN, Hruska KA, Mathew S, Goltzman D (2006) New insights into mineral and skeletal regulation by active forms of vitamin D. Kidney Int 69:218–223CrossRefPubMed Hendy GN, Hruska KA, Mathew S, Goltzman D (2006) New insights into mineral and skeletal regulation by active forms of vitamin D. Kidney Int 69:218–223CrossRefPubMed
2.
go back to reference Adorini L, Penna G (2008) Control of autoimmune diseases by the vitamin D endocrine system. Nat Clin Pract Rheumatol 4:404–412CrossRefPubMed Adorini L, Penna G (2008) Control of autoimmune diseases by the vitamin D endocrine system. Nat Clin Pract Rheumatol 4:404–412CrossRefPubMed
3.
go back to reference Orbach H, Zandman-Goddard G, Amital H, Barak V, Szekanecz Z, Szucs G et al (2007) Novel biomarkers in autoimmune diseases: prolactin, ferritin, vitamin D, and TPA levels in autoimmune diseases. Ann N Y Acad Sci 1109:385–400CrossRefPubMed Orbach H, Zandman-Goddard G, Amital H, Barak V, Szekanecz Z, Szucs G et al (2007) Novel biomarkers in autoimmune diseases: prolactin, ferritin, vitamin D, and TPA levels in autoimmune diseases. Ann N Y Acad Sci 1109:385–400CrossRefPubMed
4.
go back to reference Kamen DL, Cooper GS, Bouali H, Shaftman SR, Hollis BW, Gilkeson GS (2006) Vitamin D deficiency in systemic lupus erythematosus. Autoimmun Rev 5:114–117CrossRefPubMed Kamen DL, Cooper GS, Bouali H, Shaftman SR, Hollis BW, Gilkeson GS (2006) Vitamin D deficiency in systemic lupus erythematosus. Autoimmun Rev 5:114–117CrossRefPubMed
5.
go back to reference Chen S, Sims GP, Chen XX, Gu YY, Chen S, Lipsky PE (2007) Modulatory effects of 1,25-Dihydroxyvitamin D3 on human B cell differentiation. J Immunol 179:1634–1647CrossRefPubMed Chen S, Sims GP, Chen XX, Gu YY, Chen S, Lipsky PE (2007) Modulatory effects of 1,25-Dihydroxyvitamin D3 on human B cell differentiation. J Immunol 179:1634–1647CrossRefPubMed
6.
go back to reference Kamen DL, Tangpricha V (2010) Vitamin D and molecular actions on the immune system: modulation of innate and autoimmunity. J Mol Med (Berl) 88:441–450CrossRef Kamen DL, Tangpricha V (2010) Vitamin D and molecular actions on the immune system: modulation of innate and autoimmunity. J Mol Med (Berl) 88:441–450CrossRef
7.
go back to reference Amital H, Szekanecz Z, Szücs G, Dankó K, Nagy E, Csépány T et al (2010) Serum concentrations of 25-OH vitamin D in patients with systemic lupus erythematosus (SLE) are inversely related to disease activity: is it time to routinely supplement patients with SLE with vitamin D? Ann Rheum Dis 69:1155–1157CrossRefPubMed Amital H, Szekanecz Z, Szücs G, Dankó K, Nagy E, Csépány T et al (2010) Serum concentrations of 25-OH vitamin D in patients with systemic lupus erythematosus (SLE) are inversely related to disease activity: is it time to routinely supplement patients with SLE with vitamin D? Ann Rheum Dis 69:1155–1157CrossRefPubMed
8.
go back to reference Souto M, Coelho A, Guo C, Mendonça L, Argolo S, Papi J et al (2011) Vitamin D insufficiency in Brazilian patients with SLE: prevalence, associated factors, and relationship with activity. Lupus 20:1019–1026CrossRefPubMed Souto M, Coelho A, Guo C, Mendonça L, Argolo S, Papi J et al (2011) Vitamin D insufficiency in Brazilian patients with SLE: prevalence, associated factors, and relationship with activity. Lupus 20:1019–1026CrossRefPubMed
9.
go back to reference Munoz-Ortego J, Torrente-Segarra V, Prieto-Alhambra D, Salman-Monte TC, Carbonell-Abello J (2012) Prevalence and predictors of vitamin D deficiency in non-supplemented women with systemic lupus erythematosus in the Mediterranean region: a cohort study. Scand J Rheumatol 41:472–475CrossRefPubMed Munoz-Ortego J, Torrente-Segarra V, Prieto-Alhambra D, Salman-Monte TC, Carbonell-Abello J (2012) Prevalence and predictors of vitamin D deficiency in non-supplemented women with systemic lupus erythematosus in the Mediterranean region: a cohort study. Scand J Rheumatol 41:472–475CrossRefPubMed
10.
go back to reference Wright TB, Shults J, Leonard MB, Zemel BS, Burnham JM (2009) Hypovitaminosis D is associated with greater body mass index and disease activity in pediatric systemic lupus erythematosus. J Pediatr 155:260–265CrossRefPubMed Wright TB, Shults J, Leonard MB, Zemel BS, Burnham JM (2009) Hypovitaminosis D is associated with greater body mass index and disease activity in pediatric systemic lupus erythematosus. J Pediatr 155:260–265CrossRefPubMed
11.
go back to reference Becker A, Fisher R, Schneider M (2001) Bone density and 25-OH vitamin D levels in women with systemic lupus erythematosus. Z Rheumatol 60:352–358CrossRefPubMed Becker A, Fisher R, Schneider M (2001) Bone density and 25-OH vitamin D levels in women with systemic lupus erythematosus. Z Rheumatol 60:352–358CrossRefPubMed
12.
go back to reference Toloza SM, Cole DE, Gladman DD, Ibañez D, Urowitz MB (2010) Vitamin D insufficiency in a large female SLE cohort. Lupus 19:13–19CrossRefPubMed Toloza SM, Cole DE, Gladman DD, Ibañez D, Urowitz MB (2010) Vitamin D insufficiency in a large female SLE cohort. Lupus 19:13–19CrossRefPubMed
13.
go back to reference Sumethkul K, Boonyaratavej S, Kitumnuaypong T, Angthararuk S, Cheewasat P, Manadee N (2013) The predictive factors of low serum 25-hydroxyvitamin D and vitamin D deficiency in patients with systemic lupus erythematosus. Rheumatol Int 33:1461–1467CrossRefPubMed Sumethkul K, Boonyaratavej S, Kitumnuaypong T, Angthararuk S, Cheewasat P, Manadee N (2013) The predictive factors of low serum 25-hydroxyvitamin D and vitamin D deficiency in patients with systemic lupus erythematosus. Rheumatol Int 33:1461–1467CrossRefPubMed
14.
go back to reference Petri M, Bello KJ, Fang H, Maqder LS (2013) Vitamin D in SLE: modest association with disease activity and urine protein/creatinine ratio. Arthritis Rheum 65:1865–1871CrossRefPubMedPubMedCentral Petri M, Bello KJ, Fang H, Maqder LS (2013) Vitamin D in SLE: modest association with disease activity and urine protein/creatinine ratio. Arthritis Rheum 65:1865–1871CrossRefPubMedPubMedCentral
15.
go back to reference Kamen DL, Alele JD (2010) Skeletal manifestations os systemic autoimmune disease. Curr Opin Endocrinol Diabetes Obes 17:540–545CrossRefPubMed Kamen DL, Alele JD (2010) Skeletal manifestations os systemic autoimmune disease. Curr Opin Endocrinol Diabetes Obes 17:540–545CrossRefPubMed
16.
go back to reference Hoffecker BM, Raffield LM, Kame DL, Nowling TK (2013) Systemic lupus and vitamin D deficiency are associated with shorter telomere length among African Americans: a case-control study. PLoS One 8(5):63725CrossRef Hoffecker BM, Raffield LM, Kame DL, Nowling TK (2013) Systemic lupus and vitamin D deficiency are associated with shorter telomere length among African Americans: a case-control study. PLoS One 8(5):63725CrossRef
17.
go back to reference Lertratankul A, Wu P, Dyer A, Urowitz M, Gladman D, Fortin P (2014) 25-Hydroxyvitamin D and cardiovascular disease in patients with systemic lupus erythematosus: data from a large international inception cohort. Arthritis Care Res (Hoboken) 66:1167–1176CrossRef Lertratankul A, Wu P, Dyer A, Urowitz M, Gladman D, Fortin P (2014) 25-Hydroxyvitamin D and cardiovascular disease in patients with systemic lupus erythematosus: data from a large international inception cohort. Arthritis Care Res (Hoboken) 66:1167–1176CrossRef
18.
go back to reference Gholamrezaei A, Bonakdar ZS, Mirbagher L, Hosseini N (2014) Sleep disorders in systemic lupus erythematosus. Does vitamin D play a role? Lupus 23:1054–1058CrossRefPubMed Gholamrezaei A, Bonakdar ZS, Mirbagher L, Hosseini N (2014) Sleep disorders in systemic lupus erythematosus. Does vitamin D play a role? Lupus 23:1054–1058CrossRefPubMed
19.
go back to reference Ruiz-Irastorza G, Gordo S, Olivares N, Egurbide MV, Aguirre C (2010) Changes in vitamin D levels in patients with systemic lupus erythematosus: effects on fatigue, disease activity, and damage. Arthritis Care Res (Hoboken) 62:1160–1165CrossRef Ruiz-Irastorza G, Gordo S, Olivares N, Egurbide MV, Aguirre C (2010) Changes in vitamin D levels in patients with systemic lupus erythematosus: effects on fatigue, disease activity, and damage. Arthritis Care Res (Hoboken) 62:1160–1165CrossRef
20.
go back to reference Mok CC, Birmingham DJ, Ho LY, Hebert LA, Song H, Rovin BH (2012) Vitamin D deficiency as marker for disease activity and damage in systemic lupus erythematosus: a comparison with anti-dsDNA and anti-C1q. Lupus 21:36–42CrossRefPubMed Mok CC, Birmingham DJ, Ho LY, Hebert LA, Song H, Rovin BH (2012) Vitamin D deficiency as marker for disease activity and damage in systemic lupus erythematosus: a comparison with anti-dsDNA and anti-C1q. Lupus 21:36–42CrossRefPubMed
21.
go back to reference Borba VZ, Vieira JG, Kasamatsu T, Radominski SC, Sato EI, Lazaretti-Castro M (2009) Vitamin D deficiency in patients with active systemic lupus erythematosus. Osteoporos Int 20:427–433CrossRefPubMed Borba VZ, Vieira JG, Kasamatsu T, Radominski SC, Sato EI, Lazaretti-Castro M (2009) Vitamin D deficiency in patients with active systemic lupus erythematosus. Osteoporos Int 20:427–433CrossRefPubMed
22.
go back to reference Hamza RT, Awwad KS, Ali MK, Hamed AI (2011) Reduced serum concentrations of 25-hydroxy vitamin D in Egyptian patients with systemic lupus erythematosus: relation to disease activity. Med Sci Monit 17:CR711–CR718CrossRefPubMedPubMedCentral Hamza RT, Awwad KS, Ali MK, Hamed AI (2011) Reduced serum concentrations of 25-hydroxy vitamin D in Egyptian patients with systemic lupus erythematosus: relation to disease activity. Med Sci Monit 17:CR711–CR718CrossRefPubMedPubMedCentral
23.
go back to reference Bonakdar ZS, Jahanshahifar L, Jahanshahifar F, Gholamrezaei A (2011) Vitamin D deficiency and its association with disease activity in new cases of systemic lupus erythematosus. Lupus 20:1155–1160CrossRefPubMed Bonakdar ZS, Jahanshahifar L, Jahanshahifar F, Gholamrezaei A (2011) Vitamin D deficiency and its association with disease activity in new cases of systemic lupus erythematosus. Lupus 20:1155–1160CrossRefPubMed
24.
go back to reference Szodoray P, Tarr T, Bazso A, Poor G, Szegedi G, Kiss E (2011) The immunopathological role of vitamin D in patients with SLE: data from a single centre registry in Hungary. Scand J Rheumatol 40:122–126CrossRefPubMed Szodoray P, Tarr T, Bazso A, Poor G, Szegedi G, Kiss E (2011) The immunopathological role of vitamin D in patients with SLE: data from a single centre registry in Hungary. Scand J Rheumatol 40:122–126CrossRefPubMed
25.
go back to reference Mok CC, Birmingham DJ, Leung HW, Hebert LA, Song H, Rovin BH (2012) Vitamin D levels in Chinese patients with systemic lupus erythematosus: relationship with disease activity, vascular risk factors and atherosclerosis. Rheumatology 51:644–652CrossRefPubMed Mok CC, Birmingham DJ, Leung HW, Hebert LA, Song H, Rovin BH (2012) Vitamin D levels in Chinese patients with systemic lupus erythematosus: relationship with disease activity, vascular risk factors and atherosclerosis. Rheumatology 51:644–652CrossRefPubMed
26.
go back to reference Yeap SS, Othman AZ, Zain AA, Chan SP (2012) Vitamin D levels: its relationship to bone mineral density response and disease activity in premenopausal Malaysian systemic lupus erythematosus patients on corticosteroids. Int J Rheum Dis 15:17–24CrossRefPubMed Yeap SS, Othman AZ, Zain AA, Chan SP (2012) Vitamin D levels: its relationship to bone mineral density response and disease activity in premenopausal Malaysian systemic lupus erythematosus patients on corticosteroids. Int J Rheum Dis 15:17–24CrossRefPubMed
27.
go back to reference Reynolds JA, Haque S, Berry JL, Pemberton P, Teh LS, Ho P et al (2012) 25-Hydroxyvitamin D deficiency is associated with increased aortic stiffness in patients with systemic lupus erythematosus. Rheumatology 51:544–551CrossRefPubMed Reynolds JA, Haque S, Berry JL, Pemberton P, Teh LS, Ho P et al (2012) 25-Hydroxyvitamin D deficiency is associated with increased aortic stiffness in patients with systemic lupus erythematosus. Rheumatology 51:544–551CrossRefPubMed
28.
go back to reference Ruiz-Irastorza G, Egurbide MV, Olivares N, Martinez-Berriotxoa A, Aguirre C (2008) Vitamin D deficiency in systemic lupus erythematosus: prevalence, predictors and clinical consequences. Rheumatology 47:920–923CrossRefPubMed Ruiz-Irastorza G, Egurbide MV, Olivares N, Martinez-Berriotxoa A, Aguirre C (2008) Vitamin D deficiency in systemic lupus erythematosus: prevalence, predictors and clinical consequences. Rheumatology 47:920–923CrossRefPubMed
29.
go back to reference Kim HA, Sung JM, Jeon JY, Yoon JM, Suh CH (2011) Vitamin D may not be a good marker of disease activity in Korean patients with systemic lupus erythematosus. Rheumatol Int 31:1189–1194CrossRefPubMed Kim HA, Sung JM, Jeon JY, Yoon JM, Suh CH (2011) Vitamin D may not be a good marker of disease activity in Korean patients with systemic lupus erythematosus. Rheumatol Int 31:1189–1194CrossRefPubMed
30.
go back to reference Fragoso TS, Dantas AT, Marques CD, Junior LFR, Melo JH, Costa AJ et al (2012) 25-Hydroxyivitamin D3 levels in patients with systemic lupus erythematosus and its association with clinical parameters and laboratory tests. Rev Bras Reumatol 52:60–65PubMed Fragoso TS, Dantas AT, Marques CD, Junior LFR, Melo JH, Costa AJ et al (2012) 25-Hydroxyivitamin D3 levels in patients with systemic lupus erythematosus and its association with clinical parameters and laboratory tests. Rev Bras Reumatol 52:60–65PubMed
31.
go back to reference Ward MM, Marx AS, Barry NN (2000) Comparison of the validity and sensitivity to change of 5 activity indices in systemic lupus erythematosus. J Rheumatol 27:664–670PubMed Ward MM, Marx AS, Barry NN (2000) Comparison of the validity and sensitivity to change of 5 activity indices in systemic lupus erythematosus. J Rheumatol 27:664–670PubMed
32.
go back to reference Gladman DD, Goldsmith CH, Urowitz MB, Bacon P, Fortin P, Ginzler E et al (2000) The Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index for systemic lupus erythematosus international comparison. J Rheumatol 27:373–376PubMed Gladman DD, Goldsmith CH, Urowitz MB, Bacon P, Fortin P, Ginzler E et al (2000) The Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index for systemic lupus erythematosus international comparison. J Rheumatol 27:373–376PubMed
33.
go back to reference Milligan SE, Hom DL, Ballou SP, Persse LJ, Svilar GM, Coulton CJ (1993) An assessment of the Health Assessment Questionnaire functional ability index among women with systemic lupus erythematosus. J Rheumatol 20:972–976PubMed Milligan SE, Hom DL, Ballou SP, Persse LJ, Svilar GM, Coulton CJ (1993) An assessment of the Health Assessment Questionnaire functional ability index among women with systemic lupus erythematosus. J Rheumatol 20:972–976PubMed
34.
go back to reference Edworthy SM (2005) Clinical manifestations of systemic lupus erythematosus. In: Harris ED, Budd RC, Firestein GS (eds) Kelley’s textbook of rheumatology. Elsevier Saunders, Philadelphia, pp 1201–1224 Edworthy SM (2005) Clinical manifestations of systemic lupus erythematosus. In: Harris ED, Budd RC, Firestein GS (eds) Kelley’s textbook of rheumatology. Elsevier Saunders, Philadelphia, pp 1201–1224
35.
go back to reference Salman-Monte TC, Torrente-Segarra V, Muñoz-Ortego J, Mojal S, Carbonell-Abelló J (2015) Prevalence and predictors of low bone density and fragility fractures in women with systemic lupus erythematosus in a Mediterranean region. Rheumatol Int 35:517–518CrossRefPubMed Salman-Monte TC, Torrente-Segarra V, Muñoz-Ortego J, Mojal S, Carbonell-Abelló J (2015) Prevalence and predictors of low bone density and fragility fractures in women with systemic lupus erythematosus in a Mediterranean region. Rheumatol Int 35:517–518CrossRefPubMed
36.
go back to reference Petri M, Perez-Gutthann S, Longenecker JC, Hochberg M (1991) Morbidity of systemic lupus erythematosus: role of race and socioeconomic status. Am J Med 91:345–353CrossRefPubMed Petri M, Perez-Gutthann S, Longenecker JC, Hochberg M (1991) Morbidity of systemic lupus erythematosus: role of race and socioeconomic status. Am J Med 91:345–353CrossRefPubMed
37.
go back to reference Alarcón GS, Roseman J, Bartolucci AA, Friedman AW, Moulds JM, Goel N et al (1998) Systemic lupus erythematosus in three ethnic groups: II. Features predictive of disease activity early in its course. Arthritis Rheum 41:1173–1180CrossRefPubMed Alarcón GS, Roseman J, Bartolucci AA, Friedman AW, Moulds JM, Goel N et al (1998) Systemic lupus erythematosus in three ethnic groups: II. Features predictive of disease activity early in its course. Arthritis Rheum 41:1173–1180CrossRefPubMed
38.
go back to reference Uribe A, Graciela S, Alarcon G, McGwin G Jr, Sandoval R, Fessler BJ et al (2004) Systemic lupus erythematosus in three ethnic groups. XVIII. Factors predictive of poor compliance with study visits. Arthritis Rheum 51:258–263CrossRefPubMed Uribe A, Graciela S, Alarcon G, McGwin G Jr, Sandoval R, Fessler BJ et al (2004) Systemic lupus erythematosus in three ethnic groups. XVIII. Factors predictive of poor compliance with study visits. Arthritis Rheum 51:258–263CrossRefPubMed
39.
go back to reference Chaiamnuay S, Chailurkit LO, Narongroeknawin P, Asavatanabodee P, Laohajaroensombat S, Chaiamnuay P (2013) Current daily glucocorticoid use and serum creatinine levels are associated with lower 25(OH) vitamin D levels in Thai patients with systemic lupus erythematosus. J Clin Rheumatol 19:121–125CrossRefPubMed Chaiamnuay S, Chailurkit LO, Narongroeknawin P, Asavatanabodee P, Laohajaroensombat S, Chaiamnuay P (2013) Current daily glucocorticoid use and serum creatinine levels are associated with lower 25(OH) vitamin D levels in Thai patients with systemic lupus erythematosus. J Clin Rheumatol 19:121–125CrossRefPubMed
40.
41.
go back to reference Lima GL, Paupitz J, Aikawa NE, Takayama L, Bonfa E, Pereira RM (2015) A randomized double-blind placebo-controlled trial of vitamin D supplementation in juvenile-onset systemic lupus erythematosus: improvement in disease activity and fatigue scores. Arthritis Care Res (Hoboken). doi:10.1002/acr.22621 Lima GL, Paupitz J, Aikawa NE, Takayama L, Bonfa E, Pereira RM (2015) A randomized double-blind placebo-controlled trial of vitamin D supplementation in juvenile-onset systemic lupus erythematosus: improvement in disease activity and fatigue scores. Arthritis Care Res (Hoboken). doi:10.​1002/​acr.​22621
42.
go back to reference Jacobs J, Korswagen LA, Schilder AM, van Tuyl LH, Dijkmans BA, Lems WF et al (2013) Six-year follow-up study of bone mineral density in patients with systemic lupus erythematosus. Osteoporos Int 24:1827–1833CrossRefPubMed Jacobs J, Korswagen LA, Schilder AM, van Tuyl LH, Dijkmans BA, Lems WF et al (2013) Six-year follow-up study of bone mineral density in patients with systemic lupus erythematosus. Osteoporos Int 24:1827–1833CrossRefPubMed
43.
go back to reference Alele JD, Kamen DL (2010) The importance of inflammation and vitamin D status in SLE-associated osteoporosis. Autoimmun Rev 9:137–139CrossRefPubMed Alele JD, Kamen DL (2010) The importance of inflammation and vitamin D status in SLE-associated osteoporosis. Autoimmun Rev 9:137–139CrossRefPubMed
44.
go back to reference Bultink IE, Lems WF, Kostense PJ, Dijkmans BA, Voskuyl AE (2005) Prevalence of and risk factors for low bone mineral density and vertebral fractures in patients with systemic lupus erythematosus. Arthritis Rheum 52:2044–2050CrossRefPubMed Bultink IE, Lems WF, Kostense PJ, Dijkmans BA, Voskuyl AE (2005) Prevalence of and risk factors for low bone mineral density and vertebral fractures in patients with systemic lupus erythematosus. Arthritis Rheum 52:2044–2050CrossRefPubMed
45.
go back to reference Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK et al (2011) The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab 96:53–58CrossRefPubMed Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK et al (2011) The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab 96:53–58CrossRefPubMed
46.
go back to reference Bolland MJ, Avenell A, Baron JA, Grey A, MacLennan GS, Gamble GD et al (2010) Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ 341:c3691CrossRefPubMedPubMedCentral Bolland MJ, Avenell A, Baron JA, Grey A, MacLennan GS, Gamble GD et al (2010) Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ 341:c3691CrossRefPubMedPubMedCentral
Metadata
Title
Prevalence and predictors of vitamin D insufficiency in supplemented and non-supplemented women with systemic lupus erythematosus in the Mediterranean region
Authors
Tarek Carlos Salman-Monte
Vicenç Torrente-Segarra
M. Almirall
Patricia Corzo
Sergi Mojal
Jordi Carbonell-Abelló
Publication date
01-07-2016
Publisher
Springer Berlin Heidelberg
Published in
Rheumatology International / Issue 7/2016
Print ISSN: 0172-8172
Electronic ISSN: 1437-160X
DOI
https://doi.org/10.1007/s00296-016-3497-0

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